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CEO Says Booneville Hospital On Road To Recovery

BOONEVILLE — Booneville Community Hospital has in recent years undergone a series of financial and operational problems that left residents of Logan County wondering whether the community-owned facility would survive.

David Hill, chief executive officer of the hospital, believes it is decidedly on the mend.

Hill, hired in August, came to Booneville from Oklahoma, where he served as president of two Integris Health-owned hospitals. Prior to that, he oversaw operation of Randolph County Medical Center, now Five Rivers Medical Center, in Pocahontas, was vice president at East Cooper Regional Medical Center in Charleston, S.C., and worked for insurance provider Blue Cross/Blue Shield.

An Arkansas native, Hill said after his children were grown he had a desire to return. “It’s a good place to be,” he said.

Hill’s decision roughly coincided with efforts toward recovery of the hospital. James C. Fields, chairman of the Booneville Community Hospital board, said a succession of turnovers in 2010 resulted in a new board with a resolve to tackle problems at the hospital.

Fields said one action included a change in administrative structure, which included replacement of the CEO.

“We set a timeline for recovery,” Fields said. Although the timeline has seen some delays, he said he is more confident about the hospital’s future than he has been since joining the board in September 2010.

“We’ve still got issues we have not solved as quickly as we would have liked,” Fields said. “We have a problem of cash flow, for instance. But we are moving forward.”

Restoring Community Confidence

Hill hit the ground running in Booneville. He quickly found himself in the process of trying to lure some specialty clinic providers back to the hospital, to revive services — such as home health — that had been languishing and to restore community confidence in the vitality and value of the local medical center.

Booneville citizens have historically exhibited support for the hospital. In 2003, voters approved a 1 percent sales tax to support its operation. In 2007, the tax issue was amended to pledge one-fourth of its $400,000 annual revenue toward bonds that went toward construction of a new, $18 million, 25-bed hospital.

A not-for-profit corporation, Booneville Community Hospital Inc. operates the hospital through a seven-member board. The city oversees collection and disbursement of the sales tax, but hospital management is independent of city government, Hill said.

Hill said the ownership of the hospital will revert to the city upon retirement of the bonded debt for is construction. The payout schedule is for 40 years. Thirty-six years remain. “For the foreseeable future, we are under the corporation,” he said.

Additional funding comes from federal funding, private insurance and private payment. Hill said the hospital also deals with nonpayment problems.

“Some don’t pay. Some can’t pay and are too proud to fill out forms that would cover their bill. And some people are simply of the opinion that we are a community hospital and ought to be free,” Hill said.

He said the hospital does not turn anyone away who cannot make payment. Last year, it wrote off $1.5 million in uncompensated care.

“It is part of our mission,” Hill said.

Hospital Awaiting Trauma Designation

The 46,000-square-foot building is in good shape. In the succession of hospitals he has managed, Hill said he has observed both the “wows” and the “what happeneds?” in design elements.

He said he finds an impressive number of “wows” in Booneville. Among them, he points to the proximity of the emergency room and surgical suite, a feature that allows for smooth patient flow in emergency.

The hospital has an emergency room that is staffed by a physician 24 hours a day. It has four examination rooms, two designed to handle trauma cases. The hospital is awaiting formal designation as a Level IV trauma center in the Arkansas Department of Health Trauma Network.

Hill said in addition to its resident clinical staff, the hospital treats patients with a rotation of specialists whose services include urology, cardiology, gynecology, podiatry and surgery. The hospital is also working on implementing electronic medical records by a 2014 federally mandated deadline.

Hill is also wooing doctors to provide care in orthopedics, pulmonology, gynecology and wound care specialists for diabetics.

BCH has a staff of 92 full-time employees, Hill said. Part-time workers bring the number on the payroll to about 120.

While the hospital has adequate surgical facilities, Hill said, local demand does require them to operate continuously. “We are not going to be doing open-heart surgery. The population doesn’t demand or support it,” he said.

But the facilities allow a doctor to perform an occasional emergency procedure and accommodate scheduled procedures such as laproscopic procedures, colonoscopies and various “lump and bump” treatments.

The hospital also does not have the resources to provide birth services. Hill said to deliver babies, BCH would need two doctors, an anesthesiologist and a surgery team ready to respond at any time every day of the year.

Hill said actions taken are all in keeping with BCH’s prime mission — taking care of the patients. That mission includes providing services the patients can get at home, rather than having to travel to a larger population center.

‘Personal Level’ Of Care

Hill said BCH, like many other rural hospitals its size, continually fights the “bigger is better” mentality. Hill has worked in both small and large hospitals. When it comes to medical care, he said, size does not necessarily matter.

“We get to know our patients on a personal level,” he said, something that is just not possible in a facility that treats hundreds of people a day.

That knowledge of a patient and his or her particular needs translates into a network of care that continues after discharge. A followup call is standard. Patients are also provided with information on where they can find support for their treatment or continued recovery. Recognizing a disease or injury can affect more than the patient, the hospital sees that family members are briefed on necessary care.

BCH continues to expand its coverage area beyond the hospital campus. In December 2011, it contracted with Magazine Schools to operate a wellness clinic on campus, a facility with an added mission of providing access to medical care three days a week. The hospital staffs the clinic with an advanced nurse practitioner and provides supervision by a doctor. Hill said the Magazine school clinic is being certified a Rural Health Clinic, a move that will increase funding for the program and expand care in a town that otherwise has no doctor.

Future Needs

Hill’s background in hospital administration and professional connections he has developed may serve him well in addressing BCH’s needs.

At a Booneville City Council meeting, Hill vowed to “look at every one of our managed care contracts with insurance companies to ensure that we’re getting paid adequately for the services that we’ve rendered.”

Hill continued, “I’ve been in this business for a while. I know what we purchase some services for at other hospitals of similar size, and just because it’s small doesn’t mean we can’t get our best possible deal.”

Hill said he also enticed retired Dr. Bill Daniel, a Booneville physician who has practiced for more than four decades, to return to BCH as a hospitalist, bringing to that position a wealth of experience and history of community medicine.

Looking ahead, Hill said BCH has a growing need for additional family practice doctors. In that, he said the hospital is faced with the same major challenge all medical services must address: an acute shortage of health-care providers.

“It is a challenge to recruit physicians. We need to find those physicians — and their families — who are willing to live and work in a rural setting,” he said. “It is easier to recruit to an urban rather than a rural setting. And we are all vying for those same providers. We’re not competing with Waldron or Paris for new doctors. Our competition is Fort Smith, Little Rock and Tulsa.”